CMAA Medical Law and Ethics 5 — Questions and Answers
Question 1: Under the False Claims Act, which action by a medical administrative assistant could result in federal penalties?
- Filing a claim for a service not rendered to obtain reimbursement (Correct answer)
- Submitting a claim with a billing code correction
- Re-filing a denied claim with additional documentation
- Using modifier codes on a claim form
Correct answer: Filing a claim for a service not rendered to obtain reimbursement
Submitting claims for services not rendered constitutes healthcare fraud under the False Claims Act and carries serious civil and criminal penalties.
Question 2: A patient overhears office staff discussing another patient's diagnosis in the waiting room. This is an example of a violation of:
- The Stark Law
- HIPAA's Privacy Rule (Correct answer)
- The Anti-Kickback Statute
- The Americans with Disabilities Act
Correct answer: HIPAA's Privacy Rule
HIPAA's Privacy Rule prohibits the disclosure of protected health information in areas where unauthorized individuals may overhear.
Question 3: Which federal law prohibits physician self-referral to healthcare entities in which the physician has a financial relationship?
- The Anti-Kickback Statute
- The Stark Law (Physician Self-Referral Law) (Correct answer)
- HIPAA
- The Affordable Care Act
Correct answer: The Stark Law (Physician Self-Referral Law)
The Stark Law prohibits physicians from referring Medicare/Medicaid patients to facilities where the physician or immediate family has a financial interest.
Question 4: A patient revokes a previously signed authorization for release of medical records. The medical office should:
- Continue releasing records under the original authorization
- Accept the revocation and stop future disclosures immediately (Correct answer)
- Require a 30-day waiting period before honoring the revocation
- Notify the receiving party and continue releases already in progress
Correct answer: Accept the revocation and stop future disclosures immediately
Under HIPAA, patients have the right to revoke authorizations at any time in writing, and the office must cease disclosures upon receipt.
Question 5: The legal concept of 'statute of limitations' in medical malpractice refers to:
- The maximum financial penalty a physician can face for malpractice
- The time period within which a patient must file a malpractice lawsuit (Correct answer)
- The number of expert witnesses required in a malpractice case
- The minimum level of negligence needed to file a lawsuit
Correct answer: The time period within which a patient must file a malpractice lawsuit
The statute of limitations sets the deadline by which a patient must initiate legal action after a malpractice incident, varying by state.
Question 6: When a patient lacks decision-making capacity and has no advance directive, healthcare decisions are typically made by:
- The attending physician alone
- A court-appointed or legally recognized surrogate decision-maker (Correct answer)
- The hospital ethics committee exclusively
- The oldest available family member automatically
Correct answer: A court-appointed or legally recognized surrogate decision-maker
In the absence of an advance directive, a legally recognized surrogate (next of kin or court-appointed guardian) makes healthcare decisions for incapacitated patients.
Question 7: Which ethical principle requires healthcare providers to distribute resources and treatment fairly among all patients?
- Autonomy
- Beneficence
- Justice (Correct answer)
- Veracity
Correct answer: Justice
Justice is the bioethical principle requiring fair, equitable, and appropriate distribution of healthcare resources and treatment.
CMAA Medical Law and Ethics 5
Under the False Claims Act, which action by a medical administrative assistant could result in federal penalties?